Long Term Care Integration Project (LTCIP)

LTCIP Workgroups

Options Workgroup - Physician Strategy (managed fee-for-service)

Goal: Similar to that of Healthy San Diego Plus (HSD+): quality, consumer-centered health and social services through improved chronic care management, but without the capitation risk.

The Planning Phase targeted specific stakeholders--physicians, community-based social service providers, consumers and caregivers--to help identify strategies and incentives for improving health promotion, care coordination, and chronic care management within the fee-for-service system. The California Endowment provided $142,000 to George Mason University’s Center for Healthy Policy, Research and Ethics, under the direction of Dr. Mark Meiners, to support the planning of this strategy in conjunction with Aging & Independence Services and San Diego LTCIP stakeholders. The deliverable is an Implementation Plan that will be brought to the County Board of Supervisors in mid-2006.

The Physician Strategy was originally initiated to address concerns of a number of physicians in the community who had self-identified as being opposed to growth in managed care, including the integrated care model envisioned and developed by local LTCIP stakeholders over the last seven years. That LTCIP vision is a single health and social service system of care management, with “no wrong door” entry into the system, a plan of care shared by all providers, and funding that is pooled to allow for flexibility and creativity in providing “seamless,” consumer-centered care. The Physician Strategy has been a part of this larger grass-roots effort over the last four years.

The LTCIP Physician Strategy planning phase effort identified major obstacles to local physician and community capacity to provide a holistic approach to comprehensive chronic care management to underserved elderly and disabled individuals in need of considerable support with managing their acute and long-term care needs. An abbreviated summary of key findings include:

• physicians are dissatisfied with current healthcare drivers, such as managed care, inadequate levels of funding for publicly subsidized care and chaotic Medicare changes;
• physician interaction with “after office” support service providers is vital to successful care as well as to physician satisfaction with their practice;
• physicians describe patient barriers to after office services, gaps in support services and transitions that are poorly orchestrated and result in revolving door hospitalizations or emergency room (ER) use;
• physicians in neighborhoods with high cultural diversity and/or high poverty rates need support in getting patients to office visits, pharmacies, ancillary services, and social support services;
• no insurance/funder reimburses for the physician or office staff doing referrals or care coordination activities for patients.

Past Physician Strategy Meetings

• February 11, 2004
  • Notes, Attachment I, Attachment II

  
  

• July 14, 2004
  • Meeting #2 Presentation, Notes

  
  

• September 8, 2004
  • Notes, Notes, Audio, Network of Care Strategy Workgroup Information

  
  

• November 10, 2004
  • Agenda
  • Presentations - House Calls: A Viable Option to Reach Patients - James F. Brinkman, MD ; Barriers to Medical Home Visits - Martie Lynch, BS, PA-C, Physician Assistant ; Medical Home Visits: After the Physician Team Leaves - Cindy Hasz, Care Manager
  • Meeting #1 Audio Recording
  • Meeting #2 Audio Recording

  
  

• January 12, 2005
  • Agenda
  • Presentation - SCAN Health Plan and the San Diego LTCIP, Tim Schwab, MD, Chief Medical/Information Officer
  • Meeting #1 Audio Recording
  • Meeting #2 Audio Recording

  
  

• February 10, 2005
  • Agenda
  • Presentation - Evidence-Based Prevention Improves Chronic Care Management, Nancy A. Whitelaw, Ph.D., Director, Center for Healthy Aging, The National Council on Aging
  • Meeting #1 Audio Recording
  • Meeting #2 Audio Recording

  
  

• July 13, 2005
  • Agenda
  • Presentations: Planning Committee PowerPoint , Challenge Center - Bill Bodry , Meeting #2 Audio Recording

  
  

• September 14, 2005
  • Agenda
  • Presentations: LTCIP Overview – Mark Meiners, Ph.D. and Final Results: ALTCI Actuarial – Branch McNeal and Maria Dominiak
  • Audio Recording

  
  

• January 11, 2006
  • Audio Recording

  
  

• March 8, 2006
  • Invitation
  • PowerPoint Presentation
  • Summary Notes

  
  

• May 9, 2006
  • Invitation
  • PowerPoint Presentation
  • Audio Recording

  
  

• May 10, 2006
  • Agenda
  • Presentations
    • Care Level Management - Personal Physician Visiting and CMHCB Demo
    • American Healthways Medicare Health Support Demo-Overview
    • Healthways MHS Demo-Personal Stories
  • Morning Audio Recording
  • Afternoon Audio Recording

  
  

*PLEASE VISIT THE PLANNING COMMITTEE PAGE AND ALL OTHER WORKGROUPS FOR RELATED INFORMATION AND DETAIL

Literature References and Related Resources:

MD Link: Partnering Physicians with Community Organizations. A toolkit from the NCOA Center for Healthy Aging to help physicians educate their colleagues on collaborating with community-based organizations that serve older adults.
(also available at www.healthyagingprograms.org)

Wendy L. Adams, MD, MPH, Helen E. McIlvain, Ph.D., Naomi L. Lacy, Ph.D. Homa Magsi,
MD, Benjamin F. Crabtree, Ph.D., Sharon K. Yenny, RNP, MS, and Michael A. Sitorius, MD.
"Primary Care for Elderly People: Why Do Doctors Find It So Hard?" The Gerontologist,
Vol. 42 No. 6, 2002, 835-842.

Thomas Bodenheimer, MD, Edward H. Wagner, MD, MPH, and Kevin Grumbach, MD.
"Improving Primary Care for Patients With Chronic Illness", JAMA, October 9, 2002, Vol.
288, No. 14, 1775-1779. (Bodenheimer Article - Part 1 (2002) pdf)

Russell L. Gruen, Stephen D. Pearson, M.D., and Troyen A. Brennan, M.D. "Physician-Citizens Public Roles and Professional Obligations," January 2004. Journal of the American Medical Association. www.sdhealth.org/PDF/PhysProfOblig.pdf

Medicare/Medicaid Integration Program (http://www.gmu.edu/departments/chpre/research/MMIP/index.html) - Center for Health Policy, Research and Ethics, George Mason University.
See technical assistance paper number 12 dealing with managed fee-for-service